This form cannot be hand written. State of Utah Department of Commerce Division of Corporations & Commercial Code Withdrawal of Registration of a Foreign Limited Liability Company Print Clear Form Limited Liability Company Name: _____________________________________________________________ Entity Number: ____________________ State of Formation: ____ This Limited Liability Company declares that it no longer conducts business in Utah and withdraws its registration to do business. This Limited Liability Company revokes the authority of its registered agent to accept service on its behalf in Utah and provides this address to which service of process may be made (16-17-301). __________________________________________________________________________________________ Street Address required, PO Box can be listed after the street address Pursuant to the provisions of the Utah Limited Liability Company Act, the undersigned Limited Liability Company adopts this Statement of Withdrawal (48-3a-911). Under penalties of perjury, I declare that this Withdrawal has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Sign here after the form is printed By: ________________________________________ Title: ______________________ Date: _____________ Signed by a person authorized by the Limited Liability Company (optional) Additional filing requirements: If the filer requests a copy of the Withdrawal an additional exact copy of the filed document along with a returnaddressed envelope with adequate first-class postage must also be submitted. Under GRAMA {63-2-201}, all registration information maintained by the Division is classified as public record. For confidentiality purposes, you may use the business entity physical address rather than the residential or private address of any individual affiliated with the entity. 05/17 American LegalNet, Inc. www.FormsWorkFlow.com